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Malzbender K, Barbarino P, Barkman Ferrell P, Bradshaw A, Brookes AJ, Díaz C, van der Flier WM, Georges J, Hansson O, Hartmanis M, Jönsson L, Krishnan R, MacLeod T, Mangialasche F, Mecocci P, Minguillon C, Middleton L, Pla S, Sardi SP, Schöll M, Suárez-Calvet M, Weidner W, Visser PJ, Zetterberg H, Bose N, Solomon A, Kivipelto M. Validation, Deployment, and Real-World Implementation of a Modular Toolbox for Alzheimer's Disease Detection and Dementia Risk Reduction: The AD-RIDDLE Project. J Prev Alzheimers Dis 2024; 11:329-338. [PMID: 38374739 DOI: 10.14283/jpad.2024.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The Real-World Implementation, Deployment, and Validation of Early Detection Tools and Lifestyle Enhancement (AD-RIDDLE) project, recently launched with the support of the EU Innovative Health Initiative (IHI) public-private partnership and UK Research and Innovation (UKRI), aims to develop, test, and deploy a modular toolbox platform that can reduce existing barriers to the timely detection, and therapeutic approaches in Alzheimer's disease (AD), thus accelerating AD innovation. By focusing on health system and health worker practices, AD-RIDDLE seeks to improve and smooth AD management at and between each key step of the clinical pathway and across the disease continuum, from at-risk asymptomatic stages to early symptomatic ones. This includes innovation and improvement in AD awareness, risk reduction and prevention, detection, diagnosis, and intervention. The 24 partners in the AD-RIDDLE interdisciplinary consortium will develop and test the AD-RIDDLE toolbox platform and its components individually and in combination in six European countries. Expected results from this cross-sectoral research collaboration include tools for earlier detection and accurate diagnosis; validated, novel digital cognitive and blood-based biomarkers; and improved access to individualized preventative interventions (including multimodal interventions and symptomatic/disease-modifying therapies) across diverse populations, within the framework of precision medicine. Overall, AD-RIDDLE toolbox platform will advance management of AD, improving outcomes for patients and their families, and reducing costs.
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Affiliation(s)
- K Malzbender
- Miia Kivipelto, MD, PhD, Center for Alzheimer's Research, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, , Phone: +46 73 99 409 22
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Vermunt L, Sutphen C, Dicks E, de Leeuw DM, Allegri R, Berman SB, Cash DM, Chhatwal JP, Cruchaga C, Day G, Ewers M, Farlow M, Fox NC, Ghetti B, Graff-Radford N, Hassenstab J, Jucker M, Karch CM, Kuhle J, Laske C, Levin J, Masters CL, McDade E, Mori H, Morris JC, Perrin RJ, Preische O, Schofield PR, Suárez-Calvet M, Xiong C, Scheltens P, Teunissen CE, Visser PJ, Bateman RJ, Benzinger TLS, Fagan AM, Gordon BA, Tijms BM. Axonal damage and astrocytosis are biological correlates of grey matter network integrity loss: a cohort study in autosomal dominant Alzheimer disease. medRxiv 2023:2023.03.21.23287468. [PMID: 37016671 PMCID: PMC10071836 DOI: 10.1101/2023.03.21.23287468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Brain development and maturation leads to grey matter networks that can be measured using magnetic resonance imaging. Network integrity is an indicator of information processing capacity which declines in neurodegenerative disorders such as Alzheimer disease (AD). The biological mechanisms causing this loss of network integrity remain unknown. Cerebrospinal fluid (CSF) protein biomarkers are available for studying diverse pathological mechanisms in humans and can provide insight into decline. We investigated the relationships between 10 CSF proteins and network integrity in mutation carriers (N=219) and noncarriers (N=136) of the Dominantly Inherited Alzheimer Network Observational study. Abnormalities in Aβ, Tau, synaptic (SNAP-25, neurogranin) and neuronal calcium-sensor protein (VILIP-1) preceded grey matter network disruptions by several years, while inflammation related (YKL-40) and axonal injury (NfL) abnormalities co-occurred and correlated with network integrity. This suggests that axonal loss and inflammation play a role in structural grey matter network changes. Key points Abnormal levels of fluid markers for neuronal damage and inflammatory processes in CSF are associated with grey matter network disruptions.The strongest association was with NfL, suggesting that axonal loss may contribute to disrupted network organization as observed in AD.Tracking biomarker trajectories over the disease course, changes in CSF biomarkers generally precede changes in brain networks by several years.
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Puig-Pijoan A, García-Escobar G, Fernández-Lebrero A, Manero Borràs R, Sánchez-Benavides G, Navalpotro-Gómez I, Cascales Lahoz D, Suárez-Calvet M, Grau-Rivera O, Boltes Alandí A, Pont-Sunyer M, Ortiz-Gil J, Carrillo-Molina S, López-Villegas D, Abellán-Vidal M, Martínez-Casamitjana M, Hernández-Sánchez J, Peña-Casanova J, Roquer J, Padrós Fluvià A, Puente-Périz V. Estudio CORCOBIA: determinación de puntos de corte de biomarcadores de enfermedad de Alzheimer en LCR en una cohorte clínica. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Puig-Pijoan A, García-Escobar G, Fernández-Lebrero A, Manero-Borràs RM, Sánchez-Benavides G, Navalpotro-Gómez I, Cascales Lahoz D, Suárez-Calvet M, Grau-Rivera O, Boltes Alandí A, Pont-Sunyer MC, Ortiz-Gil J, Carrillo-Molina S, López-Villegas D, Abellán-Vidal MT, Martínez-Casamitjana MI, Hernández-Sánchez JJ, Peña-Casanova J, Roquer J, Padrós Fluvià A, Puente-Périz V. The CORCOBIA study: Cut-off points of Alzheimer's disease CSF biomarkers in a clinical cohort. Neurologia 2022:S2173-5808(22)00084-0. [PMID: 35961506 DOI: 10.1016/j.nrleng.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION The analysis of the core biomarkers of Alzheimer's Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). METHODS Prospective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer's Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aβ42, Aβ40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups. RESULTS The resulting cut-offs and their AUC were the following: Aβ42 750 pg/mL (AUC 0.809); Aβ42/Aβ40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aβ42/tTau 1.76 (AUC 0.86); Aβ42/pTau181 10.25 (AUC 0.86). CONCLUSIONS The determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aβ42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.
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Affiliation(s)
- A Puig-Pijoan
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - G García-Escobar
- Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - A Fernández-Lebrero
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Barcelonaβeta Brain Research Center (BBRC), Fundació Pasqual Maragall, Barcelona, Spain
| | - R M Manero-Borràs
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - G Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Fundació Pasqual Maragall, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain
| | - I Navalpotro-Gómez
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Barcelonaβeta Brain Research Center (BBRC), Fundació Pasqual Maragall, Barcelona, Spain
| | - D Cascales Lahoz
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - M Suárez-Calvet
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Barcelonaβeta Brain Research Center (BBRC), Fundació Pasqual Maragall, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - O Grau-Rivera
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Barcelonaβeta Brain Research Center (BBRC), Fundació Pasqual Maragall, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - A Boltes Alandí
- Servei de Neurologia, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - M C Pont-Sunyer
- Servei de Neurologia, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - J Ortiz-Gil
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain; Unitat de Psicologia, Hospital General de Granollers, Granollers, Barcelona, Spain; Fundación para la Investigación y Docencia Maria Angustias Gimenez (FIDMAG), Sant Boi de Llobregat, Barcelona, Spain
| | - S Carrillo-Molina
- Servei de Neurologia, Hospital General de Granollers, Granollers, Barcelona, Spain; Unitat de Psicologia, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - D López-Villegas
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain
| | - M T Abellán-Vidal
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain
| | - M I Martínez-Casamitjana
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain
| | | | - J Peña-Casanova
- Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - J Roquer
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain
| | - A Padrós Fluvià
- Laboratori de Referència de Catalunya, Sant Boi de Llobregat, Barcelona, Spain
| | - V Puente-Périz
- Unitat de Deteriorament Cognitiu i Transtorns del Moviment, Servei de Neurologia, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Farmacologia Integrada i Neurociència de Sistemes, Programa de Neurociències, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Franzmeier N, Suárez-Calvet M, Frontzkowski L, Moore A, Hohman TJ, Morenas-Rodriguez E, Nuscher B, Shaw L, Trojanowski JQ, Dichgans M, Kleinberger G, Haass C, Ewers M. Higher CSF sTREM2 attenuates ApoE4-related risk for cognitive decline and neurodegeneration. Mol Neurodegener 2020; 15:57. [PMID: 33032659 PMCID: PMC7545547 DOI: 10.1186/s13024-020-00407-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background The Apolipoprotein E ε4 allele (i.e. ApoE4) is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD). TREM2 (i.e. Triggering receptor expressed on myeloid cells 2) is a microglial transmembrane protein brain that plays a central role in microglia activation in response to AD brain pathologies. Whether higher TREM2-related microglia activity modulates the risk to develop clinical AD is an open question. Thus, the aim of the current study was to assess whether higher sTREM2 attenuates the effects of ApoE4-effects on future cognitive decline and neurodegeneration. Methods We included 708 subjects ranging from cognitively normal (CN, n = 221) to mild cognitive impairment (MCI, n = 414) and AD dementia (n = 73) from the Alzheimer’s disease Neuroimaging Initiative. We used linear regression to test the interaction between ApoE4-carriage by CSF-assessed sTREM2 levels as a predictor of longitudinally assessed cognitive decline and MRI-assessed changes in hippocampal volume changes (mean follow-up of 4 years, range of 1.7-7 years). Results Across the entire sample, we found that higher CSF sTREM2 at baseline was associated with attenuated effects of ApoE4-carriage (i.e. sTREM2 x ApoE4 interaction) on longitudinal global cognitive (p = 0.001, Cohen’s f2 = 0.137) and memory decline (p = 0.006, Cohen’s f2 = 0.104) as well as longitudinally assessed hippocampal atrophy (p = 0.046, Cohen’s f2 = 0.089), independent of CSF markers of primary AD pathology (i.e. Aβ1–42, p-tau181). While overall effects of sTREM2 were small, exploratory subanalyses stratified by diagnostic groups showed that beneficial effects of sTREM2 were pronounced in the MCI group. Conclusion Our results suggest that a higher CSF sTREM2 levels are associated with attenuated ApoE4-related risk for future cognitive decline and AD-typical neurodegeneration. These findings provide further evidence that TREM2 may be protective against the development of AD.
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Affiliation(s)
- Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany.
| | - M Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - Lukas Frontzkowski
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany
| | - Annah Moore
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, USA
| | - Estrella Morenas-Rodriguez
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Brigitte Nuscher
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leslie Shaw
- Center for Neurodegenerative Disease Research, Institute on Aging, Perelman School of Medicine University, Philadelphia, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | | | - Christian Haass
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig Maximilian University (LMU), Munich, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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Milà-Alomà M, Salvadó G, Shekari M, Grau-Rivera O, Sala-Vila A, Sánchez-Benavides G, Arenaza-Urquijo EM, González-de-Echávarri JM, Simon M, Kollmorgen G, Zetterberg H, Blennow K, Gispert JD, Suárez-Calvet M, Molinuevo JL. Comparative Analysis of Different Definitions of Amyloid-β Positivity to Detect Early Downstream Pathophysiological Alterations in Preclinical Alzheimer. J Prev Alzheimers Dis 2020; 8:68-77. [PMID: 33336227 DOI: 10.14283/jpad.2020.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Amyloid-β (Aβ) positivity is defined using different biomarkers and different criteria. Criteria used in symptomatic patients may conceal meaningful early Aβ pathology in preclinical Alzheimer. Therefore, the description of sensitive cutoffs to study the pathophysiological changes in early stages of the Alzheimer's continuum is critical. Here, we compare different Aβ classification approaches and we show their performance in detecting pathophysiological changes downstream Aβ pathology. We studied 368 cognitively unimpaired individuals of the ALFA+ study, many of whom in the preclinical stage of the Alzheimer's continuum. Participants underwent Aβ PET and CSF biomarkers assessment. We classified participants as Aβ -positive using five approaches: (1) CSF Aβ42 < 1098 pg/ml; (2) CSF Aβ42/40 < 0.071; (3) Aβ PET Centiloid > 12; (4) Aβ PET Centiloid > 30 or (5) Aβ PET Positive visual read. We assessed the correlations between Aβ biomarkers and compared the prevalence of Aβ positivity. We determined which approach significantly detected associations between Aβ pathology and tau/neurodegeneration CSF biomarkers. We found that CSF-based approaches result in a higher Aβ-positive prevalence than PET-based ones. There was a higher number of discordant participants classified as CSF Aβ-positive but PET Aβ-negative than CSF Aβ-negative but PET Aβ-positive. The CSF Aβ 42/40 approach allowed optimal detection of significant associations with CSF p-tau and t-tau in the Aβ-positive group. Altogether, we highlight the need for sensitive Aβ -classifications to study the preclinical Alzheimer's continuum. Approaches that define Aβ positivity based on optimal discrimination of symptomatic Alzheimer's disease patients may be suboptimal for the detection of early pathophysiological alterations in preclinical Alzheimer.
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Affiliation(s)
- M Milà-Alomà
- José Luis Molinuevo, Alzheimer Prevention Program - Barcelonaβeta Brain Research Center, Wellington 30, 08005, Barcelona, Spain, +34933160990, E-mail: ; Marc Suárez-Calvet, Alzheimer Prevention Program - Barcelonaβeta Brain Research Center, Wellington 30, 08005, Barcelona, Spain, +34933160990, E-mail:
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Martí-Fàbregas J, Martínez-Ramírez S, Martínez-Corral M, Díaz-Manera J, Querol L, Suárez-Calvet M, De Juan M, Santaló M, Marín R, Martí-Vilalta JL. Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage. Eur J Neurol 2008; 15:1085-90. [DOI: 10.1111/j.1468-1331.2008.02254.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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